Several states have made abortion illegal following the Dobbs v. Jackson case that found the Constitution does not confer a right to abortion in June 2022, but services remain available in Maryland. Providers there face challenges, however, and are working to address them.
Maryland reproductive health leaders are working to safeguard sensitive patient and provider information for people traveling across state borders to receive reproductive healthcare. They discussed their efforts to protect patient privacy at the 2024 Maryland State of Reform Health Policy Conference.
“We are the southernmost state on the East Coast that really protects reproductive rights, so we’re seeing a lot [of patients] come into the state,” said Elizabeth Edsall Kromm, director of the Prevention & Health Promotion Administration at the Maryland Department of Health.
Robyn Elliott, managing partner for Public Policy Partners, said Maryland was the first state to adopt legislation stating that information about abortions and other sensitive reproductive health services cannot be shared without the expressed consent of the patient.
“After the Dobbs decision, I think everyone in the reproductive health field knew that it was going to be a public health emergency,” Elliott said.
Elliott discussed state bans against those traveling from states where abortion is illegal to states where it is legal, like California and Maryland. States that have abortion bans can target patients and physicians with prosecution, prison time, monetary fines, and loss of professional licenses. Elliott noted that some bans also apply to those seeking gender-affirming care.
“We have seen almost half the states enact some kind of bans, particularly for minors,” Elliott said.
In 2023, Maryland passed a Reproductive Freedom Bill Package that included a shielding law, which prevents courts from delivering requests for information on any providers or patients to states with abortion bans. The process of sharing electronic health records (EHRs) between healthcare providers raises additional concerns.
“With EHRs and the interoperability with records, really all that (an) attorney probably has to do in Texas [where abortions are banned] is to go ask the person’s primary care provider in Texas, because all records are shared to some degree now,” Elliott said.
In order to preserve access to reproductive healthcare and close loopholes, Elliott said state officials need to think about how to protect the privacy of these records. She said there needs to be a balance with keeping health data private while remaining able to share data, including EHRs.
“A very large number of people are now going outside of the formal healthcare system to self-manage their own abortions. This may or may not be alarming,” Elliott said.
Elliott said data shows that patients are capable of managing their own care, as long as they have access to true abortion medication, like Mifepristone. If healthcare professionals want patients to continue to engage with the healthcare system for reproductive health services, it’s essential for them to figure out how to maintain trust, Elliott added.
Nichole Sweeney, general counsel and chief privacy officer of Chesapeake Information System for our Patients (CRISP), said in an ideal world, EHRs would be built around patients and their choices.
“That is not what we have right now. We have EHRs that are based on payment,” Sweeney said.
Elliott noted that there have been updates to HIPAA regulations to address the issue, but they aren’t enough.
“What we really, really need is for the EHR and the data systems…to center the consumer in building the systems,” Elliott said.